An Educational Intervention Decreases Opioid Prescribing After General Surgical Operations
An Educational Intervention Decreases Opioid Prescribing After General Surgical Operations
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DOI：
10.1097/sla.0000000000002198
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发表时间：
2018-03-01
影响因子：
9
通讯作者：
Barth, Richard J., Jr.
中科院分区：
文献类型：
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作者：
Hill, Maureen V.;Stucke, Ryland S.;Barth, Richard J., Jr.
目的：本研究的目的是确定教育干预是否足以减少阿片类药物处方后，一般外科options.Summary背景资料：我们最近分析了阿片类药物处方和使用5种常见的门诊手术在我们的机构：部分乳房切除术（PM）、PM伴前哨淋巴结活检（PM SLNB）、腹腔镜胆囊切除术（LC）、腹腔镜腹股沟疝修补术（LIH），开放式腹股沟疝修补术（IH）。我们发现阿片类药物被过度使用。我们制定了阿片类药物处方的指导方针，将处方药丸的数量减半，并满足80%的患者的阿片类药物requirements.Methods：我们讨论了我们的研究结果和阿片类药物处方指南与外科医生在我们的机构。我们建议外科医生鼓励患者在使用阿片类药物之前使用非甾体抗炎药（NSAID）和对乙酰氨基酚。结果：每次手术的阿片类药物处方平均数量明显减少：PM 19.8对5.1; PM SLNB 23.7对9.6; LC 35.2对19.4; LIH 33.8对19.3; IH 33.2对18.3; P均< 0.0003。与教育干预前的处方数量相比，处方的药丸总数减少了53%。仅1例患者（0.4%）需要补充阿片类药物处方。85%的患者使用NSAID或acetaminophen.Conclusions：通过患者调查和传播阿片类药物处方给外科医生的具体操作指南，通过定义术后阿片类药物的需求，我们能够减少最初规定的阿片类药物的数量超过一半。减少初始阿片类药物处方并没有导致增加阿片类药物补充处方。
Objective: The aim of this study was to determine whether an educational intervention was sufficient to decrease opioid prescribing after general surgical operations.Summary of Background Data: We recently analyzed opioid prescription and use for 5 common outpatient operations at our institution: partial mastectomy (PM), PM with sentinel lymph node biopsy (PM SLNB), laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH), and open inguinal hernia repair (IH). We found that opioids were over-prescribed. We formulated guidelines for opioid prescribing that would halve the number of pills prescribed and also satisfy 80% of patients' opioid requirements.Methods: We discussed our findings and opioid-prescribing guidelines with surgeons at our institution. We recommended that surgeons encourage patients to use a nonsteroidal anti-inflammatory drug (NSAID) and acetaminophen before using opioids. We then evaluated opioid prescriptions and use in 246 subsequent patients undergoing these same operations.Results: The mean number of opioid pills prescribed for each operation markedly decreased: PM 19.8 versus 5.1; PM SLNB 23.7 versus 9.6; LC 35.2 versus 19.4; LIH 33.8 versus 19.3, and IH 33.2 versus 18.3; all P < 0.0003. The total number of pills prescribed decreased by 53% when compared with the number that would have been prescribed before the educational intervention. Only 1 patient (0.4%) required a refill opioid prescription. Eighty-five percent of patients used either a NSAID or acetaminophen.Conclusions: By defining postoperative opioid requirements through patient surveys and disseminating operation-specific guidelines for opioid prescribing to surgeons, we were able to decrease the number of opioids initially prescribed by more than half. Decreased initial opioid prescriptions did not result in increased opioid refill prescriptions.